Bringing South African Men into HIV Counseling and Testing (HCT) and Care

 描述（由申请人提供）：本研究的最终目标是提供基于证据的策略，以改善HIV阳性男性的治疗。治疗即预防（TasP）只能通过三个步骤来发挥作用：（1）对相当大比例的人口进行检测，（2）与护理挂钩，（3）对相当大比例的艾滋病毒阳性者进行护理，直至病毒得到抑制。增加对男子的检测、联系和护理的好处将是巨大的。 我们提出了一项研究，结合结构和个人层面的干预措施，并整合结果，以解决我们的总体目标，维护护理的病毒抑制点。 目标1：在一项随机分组研究中，我们将调查以男性为中心的动员和测试是否使接受测试的男性（在过去12个月内）的人口比例增加了10个绝对百分点以上。 目标二：在个体随机设计中，我们将研究POC CD4检测和个体化病例管理是否比单独的POC CD4检测和标准治疗更能改善与护理（诊断后立即）和病毒抑制（12个月后）的联系。 目标3：整合两个试验部分（目标1和2）的结果，以评估干预措施对接受有效检测、与护理相关并保持检测不到VL的艾滋病毒阳性男性百分比的联合影响。 增加对男子的检测、联系和护理的好处将是巨大的。男子将保持更长时间的健康，可以工作和养家糊口，为家庭经济资源作出贡献而不是耗尽家庭经济资源，抚养子女，他们将不太可能将艾滋病毒传染给女性伴侣

 DESCRIPTION (provided by applicant): The ultimate objective of this research is to provide evidence-based strategies to improve treatment of HIV+ men. Treatment as prevention (TasP) can only work through a three step process: (1) Testing a significant proportion of the population, (2) linkage to care and (3) maintaining in care a significant proportion of HIV+ individuals to the point of viral suppression. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. We propose a study that combines structural and individual level interventions and integrates the results to address our overall objective of maintenance in care to the point of viral suppression. Aim 1: In a cluster-randomized study, we will investigate whether male-centered mobilization and testing increases the population-level percentage of men who have been tested (within the last 12 months) by more than 10 absolute percentage points. Aim 2: In the individually-randomized design, we will investigate whether POC CD4 testing and individualized case management improves linkage to care (immediately following diagnosis) and viral suppression (12 months later) over POC CD4 testing alone and standard of care. Aim 3: Integrate the results of the two trial components (Aims 1 and 2) to evaluate the joint effect of the interventions on the percentage of HIV+ men who are effectively tested, linked to care and maintained with undetectable VL. The benefits of increased testing, linkage to and maintenance in care for men would be enormous. Men would remain healthier longer, could work and support their families, contribute to rather than deplete household economic resources, raise their children, and they would be less likely to transmit HIV to female partners